by Ray Levy Uyeda

This story was originally published at Prism.

Although COVID-19 has been linked to a documented 628,000 American deaths, just over half of the country’s residents are fully vaccinated against the virus. The continuing pressure for the country to “reopen” grows in tandem with the force of the COVID-19 delta variant, which is responsible for rising infection and hospitalization rates. Simultaneously, some continue to blame individuals for their failure to seek vaccination despite evidence that many people aren’t vaccine hesitant because they don’t want it at all—rather, they’re worried about being able to take time off from work to get vaccinated and recover from any potential side effects. Now with full FDA approval of the Pfizer COVID-19 shots leading to a cascade of employer-imposed vaccine mandates, advocates say there’s increased urgency for employers to ensure Black and brown workers have the access and worker protections they need to get vaccinated. Paid sick leave is at the top of the list.

While COVID-19 vaccine side effects—ranging from flu-like symptoms of fever, chills, and muscle pains—are reportedly rare and short-lived, according to the Centers for Disease Control, a survey by the Kaiser Family Foundation found that Black and Latinx respondents were more likely than white respondents to cite side effects as a reason they haven’t gotten vaccinated. While respondents often list multiple reasons for not seeking out vaccination, the report found that “[m]any express work-related concerns, including half (48%) who say they are concerned they might miss work if the vaccine side effects make them feel sick and one in five who say they are concerned they may need to time off work to go and get the vaccine.”

Experts say that those most likely to work low-wage jobs are those who can least afford to absorb the expenses of their own time off. And while remote employment options have increased during the pandemic, worker benefits, income, and education level are closely tied with whether or not one has to report to work at a physical location. For instance, just over 13% of the U.S. adult population worked from home because of the pandemic, says Elise Gould, senior economist at the Economic Policy Institute. According to Gould, treating health benefits in employment as additive rather than a preventative public health measure has contributed to the problem. Additionally, as work benefits are based on the “luck of the draw where you work,” wages and labor standards can differ widely from workplace to workplace, and research has shown that low-wage workers are far less likely to be able to earn paid sick days than higher wage workers.

“There’s a need for a national standard to provide a minimum number of paid sick days,” Gould said. “We are pretty much one of the only [wealthy] countries in the world … that does not have paid family medical leave [and] paid sick days.”

A matter of public health

Paid sick leave isn’t guaranteed by the federal government, the consequences of which are largely borne by Black, Indigenous, and other workers of color. In 2019, the Bureau of Labor Statistics reported a study that evaluated paid time off and sick leave by demographic information, like race, ethnicity, and formal educational attainment, found that Black and Latinx workers are less likely than white workers to have access to paid leave. Those without college degrees were also less likely to have access to paid leave: Those with a bachelor’s degree or higher are 25% more likely to work from home than those without. Employees who aren’t able to work in the safety of an isolated home environment have less flexibility when it comes to sick leave and even less financial flexibility, forcing them to make decisions that could lead to the spread of COVID-19. And according to Gould, of the lowest earning 10% of workers are far less likely to have access to sick leave compared with an overwhelming majority of the top 10% of earners. Simply put, high earners have the fewest barriers to access and are more likely to have a flexible work schedule, while low earners face a constellation of barriers, one of which is a rigid work schedule.

Current CDC guidance to employers suggests that workers should be offered non-punitive sick leave, but even as the pandemic drags on and vaccination rates remain lower than hoped, the federal government still hasn’t required employers to provide paid sick leave to cover vaccination and side effects, though it does have the authority to do so, says Dorit Reiss, professor of law at University of California, Hastings. According to the Bureau of Labor Statistics, 25% of private industry workers are not guaranteed paid sick leave. Ironically those who are the least protected and least guaranteed paid sick leave are many of the workers deemed “essential” during the pandemic—namely, those working in service, construction, and farming industries, over 40% of whom lack paid sick leave.

“I want to remind you that while we have some federal protection of sick leave, it’s very limited,” Reiss says. “We generally don’t support people in that way. Compared to practically every other developed country, we have a very stingy support network.”

Some corporations and workplaces, like Starbucks and Walmart, have publicized company protocol offering employees paid time off to receive the vaccine or take emergency paid leave for vaccine side effects. It’s unclear how much of their respective workforces are vaccinated, but research shows that employers play a central role in mitigating vaccine hesitancy.

Lunna Lopes, a survey analyst for the public opinion and survey research team of the Kaiser Family Foundation, says that for workers with a household income under $40,000, just over half said they’d be more likely to get the vaccine if their employer offered paid time off to get vaccinated and recover from any side effects. In an April survey of unvaccinated people, Lopes says that 28% of respondents would be more likely to get the vaccine if their employer offered paid leave. The Kaiser Family Foundation also broke down the data by race.

“I think a lot of people who are working from home may not be using their paid sick days because they’re just working from home anyway, so it may not even seem as necessary,” Gould added. “But for people who have to go into work or have to send their kids to school sick because they don’t have paid sick days … those are very difficult choices to make.”

Vaccine mandates don’t change inflexible work hours

For those low-wage employees working less flexible work hours with fewer employer-offered benefits, the risk of taking a sick day might mean risking their job. Reiss says that because most employment in the U.S. is “at-will,” employers can fire workers at any time if they think workers are “taking unjustified leave.” The only mitigating apparatus to protect sick workers might be the Americans with Disabilities Act, but that law likely doesn’t apply to workers with vaccine side effects.

Gould pointed out that the question of paid sick leave for vaccination—and especially when vaccination is required for employment—is reflective of multiple forms of economic disempowerment like wage inequity that disproportionately negatively impact Black and brown people, immigrants, and undocumented people.

Disparate government responses to the onset of the pandemic around the world demonstrate that the U.S. federal response to COVID-19 protracted its worst impacts, leading to higher infection and mortality rates, as well as creating and sustaining an economic crisis. Prior to the pandemic, nearly 40% of Americans could not afford an emergency $400 expense. Eighteen months after the implementation of the country’s first COVID-19 shelter-in-place orders, millions of renters can’t afford monthly living expenses and may face eviction without the protection of a moratorium and over 50 million face difficulty getting enough food to survive.

One study conducted by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy linked income with vaccine uptake more directly, finding that rates of vaccination were higher in U.S. counties with less medically vulnerable residents. And the government response to the pandemic has widened the gap between the lowest and highest earners in the U.S. as well as between white people and BIPOC—white people have a job recovery rate of 60% compared to that of Black people at 33%, leading to further economic disparities.

In lieu of paying for people’s time while they get the vaccine, Reiss says that if we’re insistent on continuing with business as usual, we have to make the vaccines as easy to get as possible, potentially bringing the vaccines to people rather than asking them to travel to a vaccination site. And while the FDA’s recent approval of the Pfizer vaccine may remove more individual vaccine hesitancy, it won’t make much of a difference if those who are now willing to get vaccinated are still faced with choosing between vaccination and their wages. Implementing mandates that target workers without putting similar pressures on employers reflects an ongoing problem where the American obsession with “personal responsibility” obscures how few choices workers really have when employers hold all the cards and the federal government does little to address the imbalance.

“We seem to be doing a lot more work on mandates than bringing [the] vaccine to people, [and] we need to do both,” Reiss said. “I think that’s generally true of our society: we tend to emphasize punitiveness [more] than solving the access [problem].”

Ray Levy-Uyeda is a Bay Area-based freelance writer who covers justice and activism. Find them on Twitter @raylevyuyeda.

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